10/28/2026
Happy Hump Day!!!!
TODAY'S CLINICAL CHALLENGE: DO YOU ASSESS OR INTERVENE?
TWO ANSWERS ARE GOING TO SOUND VERY REASONABLE!
A clinical social worker has been providing outpatient treatment to a 32-year-old client diagnosed with schizophrenia. The client has remained psychiatrically stable for approximately eight months while receiving medication management and supportive therapy.
During a regularly scheduled session, the client reports hearing a voice that began several days ago.
The client states:
"The voice keeps telling me to hurt my neighbor. I don't want to do that. I've never hurt anybody because of a voice before, but it keeps coming back, and it's starting to scare me."
The client appears anxious but is oriented, communicates coherently, and remains engaged in the session.
The client denies wanting to harm the neighbor.
However, the social worker has not yet determined whether the client believes the voice has authority over their actions, whether the client has access to weapons, or how effectively the client can resist the commands.
What should the social worker do FIRST?
A. Arrange an urgent psychiatric evaluation to address the new command hallucinations and determine whether medication adjustments are necessary.
B. Consult the client's treating psychiatrist about the change in symptoms, obtain information about medication adherence, and coordinate further treatment recommendations.
C. Collaboratively develop a safety plan addressing the distressing voices, identify supportive individuals who may assist the client, and increase the frequency of outpatient contact.
D. Conduct an immediate, focused risk assessment addressing the client's intent, access to means, perception of the voice's authority, history of following commands, and ability to resist, then determine the appropriate protective response.
DON'T ANSWER TOO FAST!
THINK CAREFULLY!
COMMIT TO YOUR ANSWER BEFORE READING THE COMMENTS!
A, B, C, OR D?
And I want you to tell me:
WHICH TWO ANSWERS DID YOU NARROW IT DOWN TO?
This is how we build clinical reasoning instead of just memorizing information!
Let's work through this one together!
